This subregion of 7 small countries represents represent about 10% of the total HIV infections in the region in 2012. Most of people affected in Central America are key populations. HIV surveillance systems are based in HIV/AIDS case reporting and integrated bio-behavioural surveillance surveys (IBBSS). The countries that have conducted studies on HIV/AIDS reporting are estimated that report between 50-60% of HIV cases except El Salvador with 90%.
IBBSS are important to track the epidemic and guide prevention in key affected populations (KAP?s). But only two countries in the region are able to construct trends over time for two KAP (MSM and FSW) and three only have conducted population size estimates for these both populations. Only two countries (Guatemala, Nicaragua) had reported plans and sufficient resources in place for the next round of studies in FSW. This lack of resource allocation may explain why there is not data for trends for the KAPs.
The quality of mortality registration data has been categorised as average or poor by PAHO report on Health in the Americas
ART coverage increased from 37% in 2003 to 55% in 2011 with 3 countries reaching close to 80% of total people eligible. This represents an increase of 21% in 2012 with over 40,000 new people on ART marking a tipping point of the epidemic, when more people are put on treatment than new HIV infections. Retention rates at 12 months are above 80% however only 2 countries reported retention at 24 and 60 months and the median value is 44%. In most countries there is an important gap in baseline CD4 count on people initiating ART.
The estimated average for PMTCT coverage was about 38% in 2011 with two countries reaching over 80% but most of them are under 50% PMTCT coverage.
To monitor impact of interventions is concentrated epidemics is a challenge as KAP are more difficult to reach. Strengthening the HIV case surveillance systems and follow up of HIV infection over time will increase accurate information on new HIV diagnosis. More solid and reliable IBSS data to monitor behaviour and new HIV infections in young KAP are needed to estimate impact of prevention programs. Linking strategic information and program interventions will enhance the knowledge of the HIV epidemic in these countries.
Monitoring CD4 count initiation for ART, retention rates and Viral Load suppression are essential information to monitor the impact of ART programs as well as monitoring the MTCT rates.